We will conduct a statewide study of access to prenatal care in California following expansions of Medicaid eligibility criteria to twice the federal poverty level & demographic change due to immigration. We will examine the extent to which personal & systems barriers act alone or in concert with financial barriers to deter adequate prenatal care utilization among women with income under 250% of poverty in different insurance & ethnic groups. We will focus particularly on women in the near-poor (101-250% of poverty) income group, who have not been studied previously. We will conduct postpartum interviews with a statewide representative sample of 10,000 women in 19 hospitals. We will collect information on use of care & potential predictors of timeliness & continuity of prenatal care including: insurance; income, country of birth, language, & other sociodemographic characteristics; knowledge & perceptions regarding care & providers; & sources of care. We also will collect information on utilization of care & birthweight from medical records. We will describe key features of prenatal care systems to control for systems barriers such as provider availability. We will oversample women without private insurance, African Americans, Latinos, & rural women. We will have adequate statistical power to do subgroup analyses providing new information. Many studies have examined barriers to prenatal care among women with poverty-level income; little is known about the characteristics, health care, & access barriers of pregnant women from 101 to 185% of poverty who are newly income-eligible for Medicaid in 24 states (eligible up to 200% in California), or of pregnant women below 250% of poverty who are privately insured. The study will identify deterrents to care among these women, providing information needed to design public & private programs that would promote optimal utilization of preventive maternal & child health services. The study will provide new information about the income distribution of pregnant women in diverse ethnic & insurance groups in California, & about Latinos & Central Americans in particular. The study will contribute methodologically by indicating the extent to which education as recorded in vital statistics corresponds with income among ethnically diverse maternity subgroups.